Malaria parasitemia after mass distribution of azithromycin to prevent child mortality in Burkina Faso: results from a cluster randomized trial

Twice-yearly mass distribution of azithromycin to children aged 1-59 months reduces all-cause child mortality. Some studies have suggested that mass azithromycin distributions may reduce malaria mortality and parasitemia, however these studies have been done in the absence of seasonal malaria chemoprevention (SMC). Here, we evaluated malaria parasitemia in a cluster randomized trial of azithromycin versus placebo in Burkina Faso that was receiving SMC. Thin and thick smears were taken from a random sample of 15 children per cluster in 40 clusters that had been receiving twice-yearly azithromycin or placebo for 36 months (6 distributions). We found no evidence of a difference in malaria parasitemia in children in azithromycin compared to placebo clusters (mean difference -6% prevalence, 95% CI -17% to 6%, P =0.33). These results suggest that reductions in malaria parasitemia may not be a major contributor to the effect of azithromycin on child mortality in settings receiving SMC.